Healthcare Provider Details

I. General information

NPI: 1134063795
Provider Name (Legal Business Name): KASSIDY CORNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 TOWN AND COUNTRY LN
HAZARD KY
41701-9524
US

IV. Provider business mailing address

PO BOX 1988
HAZARD KY
41702-1988
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1300
  • Fax:
Mailing address:
  • Phone: 606-439-1300
  • Fax: 606-439-1400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4053989
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: